Low Health Literacy Is Associated With Frailty and Reduced Likelihood of Liver Transplant Listing: A Prospective Cohort Study.
Low Health Literacy Is Associated With Frailty and Reduced Likelihood of Liver Transplant Listing: A Prospective Cohort Study.
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DOI：
10.1002/lt.25830
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Serper M
中科院分区：
文献类型：
--
作者：
Bittermann T;Dwinnells K;Chadha S;Wolf MS;Olthoff KM;Serper M
低健康素养（HL）对终末期肝病（ESLD）结局的影响在很大程度上尚不清楚。在接受肝移植（LT）评价的ESLD门诊患者的前瞻性队列中研究了低HL与临床结局的相关性。从2014年到2017年，276名患者接受了LT评估，评估了肝脏疾病的严重程度，医学和心理社会共病，身体虚弱和营养不良。识字率是用最新的生命体征来衡量的，这是一种经过验证的简短评估。多变量模型评估HL和临床结局之间的关系，调整临床和心理社会变量。研究样本的终末期肝病模型-钠评分中位数为15（四分位数范围，11-19），71名（25.7%）候选人虚弱，117名（42.4%）营养不良，151名（54.7%）肝性脑病，104名（37.7%）低HL，85名（39.2%）社会支持边缘或较差。校正教育水平、社会经济因素和疾病严重程度后，低HL与身体虚弱（校正比值比[aOR]，3.59; 95%置信区间[CI]，1.50-8.59; P = 0.004）和未列入等待名单（aOR 1.96; 95% CI，1.03-3.75; P = 0.04）独立相关。强有力的社会支持减弱了低HL和未被列入等待名单之间的关系（aOR，1.58; 95%CI，0.74-3.36; P = 0.24）。低HL是ESLD患者中常见的且基本未被认识到的不良健康结局的风险因素。在卫生系统层面需要以患者为导向的基础设施和支持，以确保所有患者都能成功地通过LT评估和等待名单的复杂过程。
The effect of low health literacy (HL) on outcomes in end-stage liver disease (ESLD) is largely unknown. The association of low HL on clinical outcomes was investigated in a prospective cohort of outpatients with ESLD undergoing liver transplantation (LT) evaluation. From 2014 to 2017, 276 patients underwent LT evaluation with assessments of liver disease severity, medical and psychosocial comorbidities, physical frailty, and malnutrition. Literacy was measured with the Newest Vital Sign, a brief validated assessment. Multivariate models assessed relationships between HL and clinical outcomes adjusting for clinical and psychosocial variables. The median Model for End-Stage Liver Disease–sodium score of the study sample was 15 (interquartile range, 11–19), 71 (25.7%) of candidates were frail, 117 (42.4%) had malnutrition, 151 (54.7%) had hepatic encephalopathy, 104 (37.7%) had low HL, and 85 (39.2%) had marginal or poor social support. Adjusting for education level, socioeconomic factors, and severity of illness, low HL was independently associated with physical frailty (adjusted odds ratio [aOR], 3.59; 95% confidence interval [CI], 1.50–8.59; P = 0.004) and not being wait-listed (aOR 1.96; 95% CI, 1.03–3.75; P = 0.04). Strong social support attenuated the relationship between low HL and not being wait-listed (aOR, 1.58; 95% CI, 0.74–3.36; P = 0.24). Low HL is common and a largely unrecognized risk factor for poor health outcomes among patients with ESLD. Patient-oriented infrastructure and support are needed at the health system level to ensure all patients can successfully navigate the complex process of LT evaluation and wait-listing.
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影响因子：
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作者：
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通讯作者：
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DOI：
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发表时间：
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影响因子：
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作者：
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